How do I know if Medicare is primary or secondary?

Providers are required to complete a Medicare Secondary Payer Questionnaire (MSPQ) upon admission of each Medicare patient. A sample of the MSPQ can be found in the Centers for Medicare & Medicaid Services’ (CMS) Internet-Only Manual (IOM), Publication 100-05, Medicare Secondary Payer Manual, Chapter 3, Section 20.2.1 (PDF, 235 KB). Hospitals are required to verify the information at least every 90 days. However, Palmetto GBA encourages all institutional providers to verify the information on a regular basis because payer sources can change at any time.

Upon completing the MSPQ, providers may then access MSP Lookup to get an idea as to whether or not Medicare is the primary or secondary payer. Providers should also access the Health Insurance Query for Home Health Agencies (HIQH) or Health Insurance Query Access (HIQA) to view any valid MSP segments that may exist on the Common Working File (CWF). Providers may also wish to access the eServices on Palmetto GBA's website to view any valid MSP segments that may exist in a beneficiary’s Medicare records.

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